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김형훈 ( Hyung Hun Kim ), 김유선 ( You Sun Kim ), 옥경선 ( Kyung Sun Ok ), 류수형 ( Soo Hyung Ryu ), 이정환 ( Jung Hwan Lee ), 문정섭 ( Jeong Seop Moon ), 이혁상 ( Hyuck Sang Lee ), 이혜경 ( Hye Kyung Lee ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.6
Chronic non-granulomatous jejunoileitis is a rare disease characterized by malabsorption, abdominal pain, and diarrhea that causes shallow ulcers in the small bowel. The etiology of chronic non-granulomatous jejunolieitis remains unknown. A 69-year-old man complained of abdominal pain and lower extremity edema. A 99m-Tc albumin scan showed increased radioactivity at the left upper quadrant, suggesting protein-losing enteropathy. A small bowel follow-through did not disclose any lesions. Wireless capsule endoscopy revealed several small bowel ulcers and strictures. A jejunoileal segmentectomy with end-to-end anastomosis was performed, and the histologic examination revealed non-granulomatous ulcers with focal villous atrophy. Ruling out all other possible diagnoses, we diagnosed our patient with chronic non-granulomatous ulcerative jejunoileitis. Postoperatively, the patient`s abdominal pain and lower extremity edema improved, and the serum albumin normalized. This is the first case of chronic non-granulomatous ulcerative jejunoileitis localized by wireless capsule endoscopy and treated successfully with segment resection. (Korean J Gastroenterol 2010;56:382-386)
A visceral artery pseudoaneurysm after ERCP is a rare adverse event that is potentially life-threatening. Most cases reported previously originated from the peripancreatic arteries, including the splenic artery, gastroduodenal artery, or pancreaticoduodenal artery. The mechanism of the occurrence of visceral artery pseudoaneurysms after ERCP has not been elucidated until now. Recently, a pseudoaneurysm rupture originating from the superior mesenteric artery after ERCP was observed in a patient without a history of pancreatitis. This paper reports this case with a review of the relevant literature.
Radiofrequency ablation (RFA) is a minimally invasive procedure that has been considered as a relatively safe treatment for patients with small hepatocellular carcinoma (HCC). However, RFA has been shown to be associated with complications including mechanical and thermal damage. A 74-year-old man with hepatitis C virus-associated HCC was admitted to our hospital. Abdominal computed tomography revealed two lobulated-HCC in segments 4 and 5. He had no medical history of hypertension and cardiac disease. During RFA, blood pressure was elevated to 200/140 mmHg. There was no evidence of pulmonary embolism, aortic dissection, or ischemic heart disease. Laboratory findings for catecholamine surge were all within normal limits. After continuous intravenous nitroglycerin and oral beta-blocker treatment, patient's blood pressure gradually decreased and back within the normal range. Hypertensive crisis after RFA treatment for HCC is rare. Most reported cases of hypertensive crisis during RFA were related to adrenal gland injury with a release of catecholamine. In our case, the site of HCC was not close to the adrenal gland, and there was no evidence of catecholamine surge. Herein, we report a very rare case of hypertensive crisis without a surge in adrenal hormones after RFA treatment for HCC. (Korean J Gastroenterol 2017;70:198-201)
Spontaneous bacterial peritonitis (SBP) is the most common infection in liver cirrhosis patients, and is not a result of surgery or intra abdominal infection. Argon plasma coagulation (APC) is an endoscopic procedure used with a high frequency electrical current for control of bleeding from gastrointestinal vascular ectasias including angiodysplasia and gastric antral vascular ectasia. This procedure is known to be safe because it uses a noncontact method. Therefore, tissue injury is minimal and up to two to three millimeters. However, we experienced a case of SBP occurring immediately after performance of APC for control of severe bleeding from angiodysplasia in the colon in a patient with liver cirrhosis and hepatocellular carcinoma. (Korean J Gastroenterol 2014,64:115-118)
A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend to be found incidentally, but should be differentiated from malignant tumors, especially in patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT) revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed for further evaluation. But abdominal US also showed atypical finding. For the confirmative diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist®, Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium was done, and the patient was diagnosed as hepatic hemangioma. (Journal of Liver Cancer 2015;15:36-40)
Oral metastatic tumor, which is uncommon and represents less than 1% of malignant oral neoplasms, usually arises from a primary mucosal or cutaneous cancer located in the head and neck regions. Metastasis of hepatocellular carcinoma (HCC) to the oral cavity, especially to gingiva, is extremely rare. A 50-year-old man, who was a chronic alcoholic and hepatitis B virus carrier, presented with abdominal distension and weight loss for the past 3 months. Three-phased contrast-enhanced abdominal CT revealed numerous conglomerated masses in the liver, suggesting huge HCCs arising in the background of liver cirrhosis with a large amount of ascites. He complained of recurrent profuse bleeding from the left upper gingival mass. A facial CT revealed an oral cavity mass destructing the left maxillary alveolar process and hard palate, which was diagnosed as metastatic HCC by an incisional biopsy. Herein, we report a case of metastatic HCC to the gingiva. (Korean J Gastroenterol 2016;68:321-325)
The pegylated interferon plus ribavirin combination therapy has been used as the primary treatment for chronic hepatitis C (CHC) but fails to produce a sustained viral response (SVR) in many patients. In recent years, the treatment of CHC has been rapidly changing because of the introduction of direct-acting antivirals (DAAs), which have a high cure rate. However, retreatment of patients after failure of the first DAA therapy is difficult. We report two rare cases of CHC that showed acquired SVR with other DAA combinations after failure to daclatasvir and asunaprevir. (Korean J Gastroenterol 2021;77:88-91)
Advanced hepatocellular carcinoma (HCC) with tumor thrombus extending through the hepatic veins, inferior vena cava, and right atrium (RA) is very rare. However, whether active treatments such as radiation, transcatheter arterial chemoembolization, and sorafenib in advanced HCC with RA involvement prolong survival is uncertain. We present a rare case of advanced HCC with tumor thrombus nearly occupying the entire RA that was treated with sorafenib. The patient received 400 mg sorafenib twice daily. However, her liver enzyme levels continued to increase and abdominal computed tomography showed an increase in the tumor size in the liver and RA. In the present case, active treatment with sorafenib was ineffective; thus, palliative care may be more beneficial in advanced HCC with extensive RA involvement. (J Liver Cancer 2018;18:142-145)